Corifollitropin alfa followed by hpHMG in GnRH agonist protocols. Two prospective feasibility studies in poor ovarian responders

• Published in: Gynecological endocrinology Vol. 31; no. 11; pp. 885 - 890
• Main Authors: Polyzos, Nikolaos P., Corona, Roberta, Van De Vijver, Arne, Blockeel, Christophe, Drakopoulos, Panagiotis, Vloeberghs, Veerle, De Vos, Michel, Camus, Michel, Humaidan, Peter, Tournaye, Herman
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.11.2015
• Subjects: Adult; Bologna criteria; Clinical Protocols; corifollitropin alfa; Feasibility Studies; Female; Fertility Agents, Female - therapeutic use; Follicle Stimulating Hormone, Human - therapeutic use; GnRH agonist; Gonadotropin-Releasing Hormone - agonists; hpHMG; Humans; Live Birth; Luteolytic Agents - administration & dosage; Menotropins - therapeutic use; Ovulation Induction - methods; Pilot Projects; poor ovarian responders; Pregnancy; Pregnancy Rate; Prospective Studies; Triptorelin Pamoate - administration & dosage; poor ovarian responders; Bologna criteria; corifollitropin alfa; GnRH agonist; hpHMG
• ISSN: 0951-3590; 1473-0766
• DOI: 10.3109/09513590.2015.1065481

In two prospective uncontrolled feasibility trials, we examined the effect of corifollitropin alfa (CFA) followed by highly purified human menopausal gonadotrophin (hpHMG) in a short flare-up gonadotropin-releasing hormone (GnRH) agonist and a long GnRH agonist protocol for women with poor ovarian response. Overall, 45 patients were treated with short flare-up and 47 patients with the long agonist protocol. All patients received a single dose of 150 μg CFA, followed by 300 IU hpHMG 7 days later, triggering with 10 000 IU hCG, CSI and day 3 embryo transfer. Ongoing pregnancy rates (OPRs) did not differ between the short 15.6% and the long 17% agonist protocol (p = 0.85). Among patients treated with the short flare-up protocol, OPRs were 20% for younger patients (<40 years old) and 12% in older women (≥40 years old), p = 0.68. Similarly, in patients treated with the long agonist protocol younger women had an OPR of 26.7% versus 12.5% in older women, p = 0.23. Among patients treated with the short flare-up, live births rate were 15% and 4.3% for younger (<40 years old) and older patients (≥40 years old), respectively, p = 0.32. Similarly, in patients treated with the long agonist protocol, live births rate were 25% and 12.9% for younger (<40 years old) and older patients (≥40 years old), respectively, p = 0.41. None of the patients reported any serious adverse event related to treatment. According to our results, CFA followed by hpHMG in a short flare-up or long GnRH agonist protocol appears to be a feasible option for poor ovarian responders. Large phase III trials are mandatory prior to introduction in clinical practice. 在两个前瞻性非控制的可行性试验中，检测对卵巢低反应妇女应用绒促卵泡素a (CFA)后应用高纯人绝经期促性腺激素（hpHMG），比较短期flare- up促性腺激素释放激素(GnRH)激动剂方案和GnRHa长方案的效果。总体，45名患者应用短期flare- up方案，47名患者应用GnRHa长方案。所有患者应用单剂量150 μg CFA，7天后应用300IU hpHMG，10000 IUhCG触发排卵，CSI和3天胚胎移植。持续妊娠率（OPRs），GnRHa短期方案的15.6%和长方案的17%间没有差异(p=0.85)。在应用短期flare-up方案的患者中，OPRs在年轻患者(<40岁)为20%，高龄患者(≥40岁)为12%，p=0.68。同样的在应用GnRHa长方案的患者中，年轻妇女OPR为26.7%，高龄妇女为12.5%, p= 0.23。在应用短期flare-up方案的患者中，年轻患者(<40岁)活产率为15%，高龄患者(≥40岁)活产率为4.3%，p=0.32。同样的，在GnRHa长方案的患者中，年轻患者(<40岁)活产率为25%，高龄患者(≥40岁)活产率为12.9%，p=0.41。没有患者报告有与治疗相关的不良事件。根据结果，在的短期flare- up方案或者GnRHa长方案中应用CFA后序贯hpHMG对卵巢低反应患者是可行性的选择。在引入临床实践前还必须有大型III期试验。